The proposed study Developing a Decision Support System to Promote Tobacco Counseling by Dentists will utilize input from general practice dentists to develop, refine, and pilot test a clinical decision support system (CDSS), the Dental Tobacco Cessation I-Pad (DEN-TC), for tobacco cessation within general practice dental offices. The USPHS guideline on tobacco cessation (the 5' As) for health care providers (Fiore et al., 2008) will also guide the design. Clinical Decision Support Systems (CDSS) have been proposed and developed to support the 5 A's in ambulatory care physician practices and in a pediatric clinic (Marcy et al., 2005, Marcy et al., 2008, Downs et al., 2008). Numerous investigations, and our own preliminary work in dental offices provide evidence that clinician behaviors with regard to Asking and Advising can be achieved, but that the remaining three A's; Assessing, Assisting and Arranging do not receive adequate attention by dental providers in the clinical setting (Albert et al, 2004, Albert et al, 2005, Gordon et al, 2006, Gordon et al, 2007). Assisting the patient with pharmacotherapeutics for tobacco cessation, has been found to increase the odds of quitting approximately 1.5 to 2 fold (Silagy et al, 2004, Gonzales et al 2006). Arranging for follow up with a proactive quit line can also substantially increase the odds of quitting. A program that fits into the routine of practice by allowing the clinician to easily gather information on the patient's tobacco history, relevant health history, medication history and stage of change/ readiness to quit adheres to Roger's Diffusion of Innovations theory and lends itself to adoption. A major goal of this study is to identify and measure mediating and moderating effects of the CDSS. We will use contextual inquiry with multiple evaluation methods to assess dentist practice preferences and dental office workflow integration. We propose a two-phase development process for definition, usability testing, and clinical testing. A manual of operations will be developed and updated throughout the study. In Phase 1 the DEN-TC system will be developed and defined and we will validity test the DEN-TC within dental offices and perform initial clinical testing with patients. In Phase 2 we will pilot test the DEN-TC intervention in general dental practices to guide the development of a large-scale trial. The proposed project is significant in that, if found to be successful, a Den-TC I-Pad such as the one proposed, could enhance adoption of the USPHS 5A's guidelines in dental practices; innovative because it uses iPads and the Apple platform to directly address provider reluctance to embrace and adopt the 5 A's guidelines for their tobacco using patients; uses a sound scientific approach that is based on previous research; and brings together an experienced team of investigators in an environment that is uniquely suited to the successful completion of the project